LESSONS LEARNED DEVELOPING A NUTRITIONAL ADHERENCE INTERVENTION FOR DEMENTIA PREVENTION: A QUALITATIVE ANALYSIS

Abstract Lifestyle interventions show considerable promise in delaying the onset and reducing risk for Alzheimer’s disease and related dementias (ADRD). Unfortunately, scalable interventions that address issues of long-term adherence have not been adequately developed or disseminated. Especially important for this effort is iterative evaluation and adaptation of interventions using participant feedback throughout the development process. Using the NIH ORBIT model for behavioral intervention development, our team has established the proof-of-concept (N=9) and pilot tested (N=58) a Mediterranean ketogenic nutrition (MKN) adherence program for older adults at risk for ADRD. This program incorporates motivational interviewing strategies and cognitive behavioral skills training to enhance uptake and long-term adherence to MKN. For each of these pilots, participants completed exit interviews at the conclusion of the 6-week, group intervention and 3-months post-intervention. Qualitative and quantitative data on the acceptability of the program, as well as detailed participant feedback about their experience and recommendations for improvements were collected. While quantitative data demonstrate high acceptability, thematic analysis of qualitative interviews demonstrate a range of recommendations for enhancing and refining important components of the intervention that will be necessary for future scaling and dissemination. We discuss important themes, future directions of this work, and implications for lifestyle intervention development more broadly.


EXAMPLES OF ENGAGING HARD-TO-REACH POPULATIONS IN CLINICAL RESEARCH
Chair: Evan Plys Discussant: Melissa Gerald Individuals, communities, and settings that are systematically and historically under-represented in research are sometimes referred to as "hard-to-reach" populations.Investigators often face additional challenges to engaging hard-to-reach populations, as research commonly occurs in settings or situations where clinical science has not historically taken place.The perspectives of hard-to-reach participants are vital for moving toward health equity.Yet, investigators must be equipped with specific strategies and tools to conduct high-quality clinical research with hard-to-reach populations.In this symposium, a diverse panel of speakers will present examples of research with various hard-to-reach patient populations and settings.The first discusses research targeting socioeconomically disadvantaged short-stay skilled nursing residents and their care-partners.This presentation highlights challenges and solutions for partnership formation, budgeting, recruitment, and engaging community advisors in skilled nursing facilities.The second centers on research with Hispanic families caring for an elder living with dementia.This presentation highlights challenges and solutions for recruitment as well as language translation and cultural adaptation of study materials.The third discusses research with incarcerated older adults and those receiving treatment from outpatient substance use disorder clinics.This presentation highlights challenges and solutions for recruitment, assessment, and adapting protocols in these settings.The final discusses research with adults receiving Hospice care for advanced cancer.This presentation highlights practical, ethical, and cultural considerations for engaging participants in their final months of life.We conclude with a broader discussion of approaching clinical research with hard-to-reach populations, with the ultimate goal of inspiring investigators to enhance the reach of their science.

BUILDING RESILIENCE IN SKILLED NURSING (BRISK): A CASE OF COMMUNITY-ENGAGED RESEARCH IN SKILLED NURSING FACILITIES
Evan Plys 1 , Christopher Lyons 2 , and Ana-Maria Vranceanu 2 , 1. Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts, United States, 2.

Massachusetts General Hospital, Boston, Massachusetts, United States
Older adults receiving post-acute rehabilitation care in a skilled nursing facility (SNF) commonly present with high physical, psychological, and social needs.Psychosocial stressors and associated consequences (e.g., poor transitions, re-hospitalizations) may be magnified among families with limited financial resources.The current study aimed to co-develop a dyadic psychological intervention tailored to meet the unique psychosocial needs of socioeconomically disadvantaged patients and their care-partners during the transition from SNF to home.In this presentation, we describe the process of partnering with SNFs and forming a community advisory board (CAB) to meet the objectives of the current study.First, we discuss practical and regulatory considerations related to identifying facility partners (e.g., facility chains, physician groups) and recruiting patientcare-partner dyads in partner facilities.Second, we highlight strategies to incentivize potential SNF partners as well as historically and systematically under-represented patient participants, including budgetary considerations, recruitment strategies, sustained contact after discharge, and clinical service provision.Third, we discuss the recruitment, formation, and role of a CAB with diverse perspectives, including patients, family care-partners, SNF staff, policy makers and advocates.Overall, this presentation will generate discussion on practical strategies for building and maintaining mutually beneficial research partnerships with SNFs and similar hardto-reach healthcare settings (e.g., long-term care facilities, home health agencies).

CHALLENGES AND OPPORTUNITIES FOR RECRUITMENT AND RETENTION OF OLDER HISPANICS FOR CLINICAL RESEARCH Rafael Samper-Ternent, UTHealth Houston, Houston, Texas, United States
Older Hispanics represented 9% of the population over 65 years of age in the USA in 2019.That number is expected to increase to 21% by 2060.Representation of older Hispanics in clinical research is not proportional to the projected increase of older Hispanics.I will discuss the lessons learned on recruitment and retention of older Hispanics and their family caregivers from a large multi-site pragmatic clinical trial I am a part of and a small pilot project I am co-leading.The pragmatic trial compares a health-system-based approach and a community-based approach to dementia care.For this pragmatic trial, 2,176 dyads of persons living with dementia and their family caregivers were recruited.More than 20% of participating dyads belong to underrepresented racial and ethnic groups and 8.8% identified as Hispanic.The pilot project tests the cultural adaptation of the Patient Priorities Care (PPC) approach for older Hispanics.For the pilot project, we recruited 5 older Hispanics with multiple chronic conditions (MCC) and 20 Hispanics with MCC and dementia.I will describe the recruitment strategies used in each study, the barriers we faced, and the approaches we think worked best for the recruitment of Hispanics.I will also reflect on the challenges we currently face to conduct pragmatic trials that include older Hispanics and the opportunities for improvement.

RECRUITING SAMPLES OF OLDER ADULTS FROM VULNERABLE GROUPS Lisa Barry, UConn Center on Aging, Farmington, Connecticut, United States
Since 2000, the number of incarcerated persons age ≥50 in the U.S. grew 280% and those in this age group with substance use disorders (SUDs) grew from 1.7 to 5.7 million.Yet, these groups, which comprise some of the most medically vulnerable persons in society, are difficult to recruit to research studies.We successfully recruited and retained 171 incarcerated persons age ≥50 in a cohort study.We will discuss how recruitment required strong partnership with the state corrections system, how we had to be cognizant of measures that were meaningful in the context of the unique environment (prison activities of daily living), and how measures were modified (when life gets hard I just want to escape).As we continue to recruit persons ≥50 seeking SUD treatment, we will discuss the usefulness of snowball recruiting and balancing decisions regarding modification of inclusion criteria while maintaining integrity of the original research question.

TECHNIQUES FOR OVERCOMING CHALLENGES TO RESEARCH WITH INDIVIDUALS NEARING THE END OF LIFE
Ellis Dillon 1 , Meghan Martinez 2 , Martina Li 2 , Alyssa Hernandez 2 , Su-Ying Liang 2 , and Manali Patel 3 , 1. UConn Health,Farmington,Connecticut,United States,2. Sutter Health,Palo Alto,California,United States,3. Stanford University,Stanford,California,United States People living with advanced disease and nearing the end of their lives are often omitted in research on healthcare and the lifespan.This omission occurs for practical, ethical, and cultural reasons.Drawing on examples from studies on individuals receiving home hospice care, and individuals with advanced cancer and their caregivers, we will review (1) practical, ethical, and cultural challenges to doing this research, (2) techniques to increase access, recruitment, and participation through developing partnerships, flexibility and resource allocation, and (3) research team training and support.Practical challenges include the unpredictability of illness and symptoms leading to cancellations and increased attrition, and increased time and resources needed to recruit, consent, and travel to community residences.Ethical and cultural challenges include concerns about "vulnerability," and stigma around directly discussing dying.Techniques to facilitate successful inclusion of these populations include developing partnerships with community organizations, clinical teams, and patient or family advocates, justifying and allocating sufficient resources and flexibility in study design and word choices to reflect the spectrum of understanding and experiences, and additional training and support for research staff.Other techniques to include this population include use of secondary data, reconsidering research exclusion criteria, and surveying/ interviewing family members and other caregivers.Hard to reach populations are often overlooked, yet they are vital to ensuring full representation of lived experience.Science benefits from developing strategies to include these populations in research.